Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett's esophagus
Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett's esophagus
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DOI：
10.1016/j.gie.2007.08.039
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发表时间：
2008-04-01
影响因子：
7.7
通讯作者：
Bergman, Jacques J. G. H. M.
中科院分区：
文献类型：
--
作者：
Peters, Femke R.;Brakenhoff, Klasina P. M.;Bergman, Jacques J. G. H. M.
背景：Barrett 瘤形成内镜切除 (ER) 的循证选择标准很少。目的：研究 Barrett 瘤形成 ER 标本的组织病理学，并将其与内镜特征相关联，为患者管理提出建议。设计、设置、干预：2000 年至 2000 年间在荷兰三级转诊中心进行的 293 次连续 ER 中获得的标本的组织学和相关内窥镜报告主要结果测量：ER标本的组织学表现及其与内镜特征的关系。结果：总共对局灶性病变进行了150例ER检查：16％0-I型，23％0-IIa，7％0-IIb，3％0-IIc，9％0-IIa-IIb和42％0-IIa-IIc； 143 表示平坦粘膜。组织学显示 57 例 ER 无异型增生，52 例为低度上皮内瘤变，104 例为高级别上皮内瘤变，61 例为 T1m，17 例为 T1sm；在两种癌症中，由于伪影，浸润深度无法评估。 0-I 型和 0-IIc 型病变明显更常穿透粘膜下层 (P = .009)：60% 为 G1 癌症，23% 为 G2 癌症，18% 为 G3 癌症。 G2-G3 癌症明显更频繁地侵入粘膜下层 (P < .001) 或具有阳性垂直切缘 (P = .015)。 ER 标本的组织学改变了 49% 局灶性病变的诊断，并导致 30% 的治疗策略发生了相关变化。局限性：回顾性研究。结论：ER 是一种有价值的诊断工具，经常导致治疗政策的改变。大多数内镜下切除的早期 Barrett 肿瘤是 0-II 型、G1 粘膜肿瘤。粘膜下浸润更常见于 0-I 型和 0-IIc 型病变以及 G2-G3 癌症。
Background: Evidence-based selection criteria for endoscopic resection (ER) of Barrett's neoplasia are scarce.Objective: To study the histopathology of ER specimens of Barrett's neoplasia and correlate this with endoscopic characteristics to make recommendations for patient management.Design, Setting, Interventions: Histology and correlating endoscopy reports of specimens obtained at 293 consecutive ERs performed at a Dutch tertiary referral center between 2000 and 2006 were reviewed.Main Outcome Measurements: Histologic findings in ER specimens and their relation with endoscopic characteristics.Results: A total of 150 ERs were performed for focal lesions: 16% type 0-I, 23% 0-IIa, 7% 0-IIb, 3% 0-IIc, 9% 0-IIa-IIb, and 42% 0-IIa-IIc; and 143 for flat mucosa. Histology revealed no dysplasia in 57 ERs, low-grade intraepithelial neoplasia in 52, high-grade intraepithelial neoplasia in 104, T1m in 61, and T1sm in 17; in two cancers, infiltration depth was not assessable because of artifacts. Type 0-I and 0-IIc lesions significantly more often penetrated the submucosa (P = .009): 60% were G1 cancers, 23% were G2 cancers, and 18% were G3 cancers. G2-G3 cancers significantly more often invaded the submucosa (P < .001) or had positive vertical margins (P = .015). Histology of ER specimens led to a change in diagnosis in 49% of the focal lesions and a relevant change in treatment policy in 30%. Limitations: A retrospective study.Conclusions: ER is a valuable diagnostic tool that frequently leads to a change in treatment policy Most endoscopically resected early Barrett's neoplasia are 0-II type, G1 mucosal neoplasia. Submucosal infiltration is more often encountered in type 0-I and 0-IIc lesions and in G2-G3 cancers.